Can switching asthma biologics help reduce severe asthma attacks?

Switching to a different biologic medication is a common strategy for people with severe asthma who do not get enough relief from their current treatment. Research shows that changing biologics can significantly lower the risk of asthma attacks, reduce emergency room visits, and improve overall asthma control. This approach also frequently allows patients to lower their dose of maintenance oral corticosteroids, which carry their own health risks. However, the success of a switch depends on matching the new drug to the specific inflammatory pattern found in the patient's airways.

What the research says

A systematic review of 49 studies involving nearly 2,300 patients found that switching biologics led to a significant reduction in asthma exacerbations and hospitalizations ¹. The review also noted improvements in lung function and asthma control scores after the switch ¹. The most common reasons for switching were suboptimal asthma control and the need to reduce oral steroid use ¹. Common switching patterns included moving from mepolizumab to benralizumab or from omalizumab to mepolizumab ¹.

The effectiveness of a switch can depend on the patient's baseline inflammation. Studies show that patients with severe asthma have different inflammatory patterns, such as eosinophilic or neutrophilic inflammation ³. While many patients respond well to biologics targeting Type 2 inflammation, some patients have Type 2-low disease where standard biologics may not work as well ². In these cases, switching to a drug like tezepelumab, which targets a different pathway upstream of both Type 2 and non-Type 2 inflammation, may provide better control ².

Experts in the Asia-Pacific region emphasize that clinical remission in severe asthma should include the elimination of exacerbations and the ability to stop using oral corticosteroids ⁴. This aligns with the findings that switching biologics helps achieve these specific goals ¹. The review also highlights that while restoring normal lung function may be difficult due to airway remodeling, maintaining stability and optimal individual lung function is a realistic and important goal ⁴.

What to ask your doctor

• What specific inflammatory pattern do I have, and which biologic is best suited for that pattern?
• If my current biologic is not working well, what are the options for switching to a different medication?
• How will switching biologics affect my risk of having severe asthma attacks or needing the emergency room?
• Can switching to a new biologic allow me to safely reduce or stop my oral steroid dose?
• Are there any new biologics, like those targeting TSLP, that might work for my specific type of asthma?